Equity in Health

An overview of reviews on strategies to reduce health inequalities
Garzón-Orjuela N; Samacá-Samacá D; Angulo S; et al: International Journal for Equity in Health 19(192), doi: https://doi.org/10.1186/s12939-020-01299-w, 2020

Governments are incentivized to develop and implement health action programs focused on equity to ensure progress with effective strategies or interventions. This study identified strategies that facilitate the reduction of health inequalities. A systematic search strategy identified 4095 articles, of which 97 were included in the synthesis. Most of the studies included focused on the general population, vulnerable populations and minority populations. The subjects of general health and healthy lifestyles were the most commonly addressed. According to the classification of the type of intervention, the domain covered most was the delivery arrangements, followed by the domain of implementation strategies. The most frequent group of outcomes was the reported outcome in (clinical) patients, followed by social outcomes. The authors note that the strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors with the health system.

Comparisons of social and demographic determinants of tobacco use in the Democratic Republic of the Congo
Colwell B; Mosema K; Bramble M; et al: Globalization and Health 16(66), doi: https://doi.org/10.1186/s12992-020-00593-0, 2020

This study examined social determinants of tobacco use in the Democratic Republic of the Congo (DRC), including region, sex, ethnicity, education, literacy, wealth index and place of residence, to gain insights on tobacco use among sub-national groups. The project analysed data from the DRC 2013–2014 Demographics and Health Survey. Tobacco use was found to be highest among working poor people, those with less education and low literacy. Older age people and those living in larger cities were more likely to smoke , although the relationship between age and smoking was not linear. Wealth was strongly related to smoking as was being engaged in services, skilled and unskilled manual labour and the army. Being in a professional, technical or managerial position was highly protective against smoking. The authors observe that the data indicate that tobacco use in the DRC, as is common in low income countries, is heavily concentrated in working poor people with lower educational status. Higher educational status is consistently predictive of avoiding tobacco use. They argue that examining only national-level data to ascertain tobacco use levels and patterns may lead to mistaken conclusions and inefficient and ineffective allocation of resources for control of tobacco use.

SADC Regional Response to COVID-19
Southern African Development Community: Bulletin 11, SADC, Botswana, August 2020

The 11th Bulletin of the SADC Response to COVID-19 in English, French and Portuguese provides an overview of the global, continental and regional situation as well as the measures that have been put in place with the support of WHO. It reports that the COVID-19 situation continues to rise in some states in the region, destabilizing the economies and other systems, and leading to a precarious food and nutrition situation. The report provides the short, medium and long term interventions that countries can put in place to address the situation in relation to issues such as food security, transport, health and economic recovery. Transport and trade facilitation is noted to remain a major challenge while noting achievements in this, including the Tripartite Guidelines on Trade and Transport Facilitation for Safe, Efficient and Cost Effective Movement of Goods and Services during the COVID-19 Pandemic which harmonise the guidelines of SADC, East African Community (EAC) and the Common Market for Eastern and Southern Africa (COMESA).

Status of COVID-19-in East and Southern Africa
Minja C: The East Central and Southern Africa Health Community (ECSA-HC), July 2020

The East Central and Southern Africa Health Community has continued to monitor the status of COVID-19 in Burundi, Eswatini, Kenya, Lesotho, Malawi, Mozambique, Mauritius, Rwanda, South Sudan, Tanzania, Uganda, Zambia and Zimbabwe and to support countries mitigate effects of COVID-19. Due to the prevailing restrictions of travel, much has been provided through online discussions and support. The report indicates that the number of reported confirmed cases of COVID-19 and cases under care in the region is increasing, in spite of the context of under-reporting. The authors note that governments wish to open up economies to take care of individual and national economic survival and call for targeted and population interventions for modified social distancing mechanisms and for support for diagnostics, care of recovering cases, contact tracing and surveillance across countries, taking note of the fluid movement of people across borders. Adopting regional collaborative efforts is argued to be cost-efficient.

The COVID-19 pandemic and health inequalities
Bambra C; Riordan R; Ford J: et al: Epidemiology & Community Health, doi: 10.1136/jech-2020-214401, 2020

This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that this is a syndemic pandemic. The authors explore the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.

Seventy Third World Health Assembly and Resolution 73.1 on the COVID-19 response
World Health Assembly: WHA 73.1 Geneva, 19 May 2020

The May 2020 session of the World Health Assembly was held as a virtual 'de minimis' meeting by video conferencing, with consideration of most items deferred to written procedure or a resumed meeting later in the year. In opening the Assembly the WHO Director General Dr Tedros Ghebreyesus stated "COVID-19 is not just a global health emergency; it is a vivid demonstration of the fact that there is no health security without resilient health systems, or without addressing the social, economic, commercial and environmental determinants of health". The full speech is available at https://apps.who.int/gb/ebwha/pdf_files/WHA73/A73_3-en.pdf. The virtual WHA discussed and endorsed a key resolution sponsored by multiple countries, including Zambia in the east and southern Africa region and the Africa group and its member states. The resolution is shown at the website provided. The chair of the Africa group noted in the deliberations the importance of making full use of the flexibilities contained in the TRIPS Agreement and the Doha Declaration on the TRIPS Agreement and Public Health and called for the transfer of technology and know-how for medicines for vaccines, diagnostics and other commodities to meet demand and ensure equity. He also called for debt relief to enable countries to meet the demands of responses and the economic impact of the pandemic. The statements by countries to the WHA73 are reported at https://apps.who.int/gb/statements/WHA73/

Human Development Report 2019. Beyond income, beyond averages, beyond today: Inequalities in human development in the 21st century
United Nations Development Programme, New York, 2019

Inequalities in human development are a roadblock to achieving the 2030 Agenda for Sustainable Development. They are not just about disparities in income and wealth and cannot be accounted for simply by using summary measures of inequality that focus on a single dimension. This 2019 Report explores inequalities in human development by going beyond income, beyond averages and beyond today. It asks what forms of inequality matter and what drives them, recognizing that pernicious inequalities are generally better thought of as a symptom of broader problems in a society and economy. It also asks what policies can tackle those drivers—policies that can simultaneously help nations to grow their economies, improve human development and reduce inequality.

The mediating role of social capital in the relationship between socioeconomic status and adolescent wellbeing: evidence from Ghana
Addae E: BMC Public Health 20(20) 1-11, 2020

This paper presents evidence on the potential for social capital to be a protective health resource by mediating the relationship between socioeconomic status and wellbeing of Ghanaian adolescents. A cross-sectional survey involving a randomly selected 2068 adolescents from 15 schools in Ghana was conducted. Relationships were assessed using multivariate regression models. Three measures of familial social capital were found to protect adolescents’ life satisfaction and happiness against the effects of socioeconomic status. There were variations in how socioeconomic status and social capital related to the different dimensions of adolescents’ wellbeing. Social capital was reported to be a significant mechanism through which socioeconomic status impacts the wellbeing of adolescents. The authors suggest that it can be utilised by public health and that the findings show that the role of the family in promoting adolescents’ wellbeing is superior to that of the school.

Children with hearing impairment in Malawi, a cohort study
Mulwafu W; Tataryn M; Polack S; Viste A; et al.: Bulletin of the World Health Organisation 97(10) 654–662, 2019

This study assessed the outcomes of children diagnosed with hearing impairment 3 years earlier in terms of referral uptake, treatment received and satisfaction with this treatment and social participation. A population-based longitudinal analysis of children with a hearing impairment was conducted in two rural districts of Malawi. Key informants within the community identified the cohort in 2013. Informants clinically screened children at baseline and by questionnaires at baseline and follow-up in 2016. 752 children were diagnosed in 2013 as having a hearing impairment and 307 traced for follow-up in 2016. Referral uptake was low, more likely among older children and less likely for those with an illiterate caregiver. Few of the children who attended hospital received any treatment and 63.6% of caregivers reported satisfaction with treatment. Difficulty making friends and communicating needs was reported for 10.0% and 35.6% of the children, respectively. Lack of school enrolment was observed for 29.5% of children, and was more likely for older children, girls and those with an illiterate caregiver. The authors propose that more widespread and holistic services are required to improve the outcomes of children with a hearing impairment in Malawi.

Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)
Harvard T.H. Chan School of Public Health, University of Witwatersrand, Johannesburg, and the INDEPTH Network: 2019

The Health and Aging Study in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) is led by an interdisciplinary team of collaborators from Harvard School of Public Health, University of Witwatersrand, Johannesburg, and the INDEPTH Network, a global network of health and demographic surveillance systems based in Ghana. By integrating the HAALSI data with cause of death data from the INDEPTH Health and Demographic Surveillance System (HDSS) data at the MRC/Wits Agincourt research site, the authors explored the interrelationships between physical and cognitive functioning, lifestyle risk factors, household income and expenditure, depression and mental health, social networks and family composition, HIV infection and cardio-metabolic disease. In South Africa, the research found that people who were participating in the national HIV treatment programme were more likely to receive care for high blood pressure and achieve control of both blood pressure and blood sugar. This finding suggests that strong primary care systems are an important part of the answer to the disease trends of older adults and that South Africa’s national HIV treatment programme may offer a great platform for expanding primary care for all South Africans. Good health habits formed in childhood and in young adulthood – including avoiding smoking and alcohol overuse, engaging in physical activity and eating a nutritious diet are identified as being crucial to healthy ageing of the society of a whole.